Filler for Forehead Wrinkle
Since I danced for Milwaukee Ballet and did my undergrad as well as medical school there I am a true Wisconsinite. I often have to add filler for forehead wrinkles after Botox. If Botox is injected for a year or more without return of muscle function and the skin continues to show the wrinkle then it's time to add filler. Any of the hyaluronic acid fillers is an excellent choice to reduce the appearance of these wrinkles.
Your photo shows a prominent vertical forehead wrinkle, which presumably remains after your botox has "set up". Your dermatologist is prudently cautious in avoiding this area because it is considered an "off label" (not approved by the FDA) indication for the hyaluronic acid fillers. The conservatism stems from the fact that the blood supply here is a "watershed" or very limited. So if an injector inadvertently injects some filler into a vessel, the area supplied by that artery could theoretically necrose (becoming intially white then black).
In filling this area, your injector should inject slowly, use a very small gauge needle, (32gauge), use very small amounts and be prepared to manage complications. In balance, this technique of combining filler with Botox is an extremely powerful one. Good luck.
Restylane or Juvderm can be used in your forehead lines
Juvederm or Restylane to fill in forehead lines is off-label like many other uses of these products. I routinely use fillers in forehead lines that do not respond completely to Botox. I have used Juvederm, Restylane, Radiesse, Evolence, Elevess on scores of patients with no complications. I think the risk of skin necrosis (barring intravascular injection) is extremely small if the product is injected intradermally by an injector experienced in this area.
Juvederm/Restylane Injected in Vertical Forehead Lines, Better When Done Concurrently with Botox
Both Juvederm and Restylane can be used "off-label" to fill the vertical forehead lines between the eyebrows (glabellar lines). In fact, when Botox and either Juvederm or Restylane is used concurrently in this area, there is a synergistic effect that creates a very long lasting (many times permanent) elimination of the lines, even when the Botox wears off.
If your dermatologist is uncomfortable injecting in that area, certainly do not have him/her inject you. You do need to choose a very well trained and experienced injector for this treatment as severe complications have been reported if injected in the incorrect manner.
Good luck and be well.
Restylane of Juvederm for vertical forehead wrinkles
I agree with other physicians. The use of fillers in this area is indeed "off-label", as it is in the lips, cheeks and many other areas. Yet, we use it frequently and it is can be a very rewarding procedure for the patients and physicians. I would only use a hyaluronic acid filler, such as Restyalne or Juvederm. Filler combined with Botox or Dysport in this area usually lasts for about 6 months or longer. There are many nuances to the technique. Since you really cannot tell your doctor how to inject it or what needle to use, make sure to find a physician who does it on a regular basis and has good results.
One should use caution for Juvederm or Restylane on the forehead
While injection into the glabellar area can cause necrosis. The key is subdermal placement without overfill. By monitoring the capillary filling disturbances in the circulation can be treated with the enzyme hyaluronidase. My best recommendation is don't make your dermatologist do something they are not comfortable with. Consider looking at the liquidfacelift.com website for the name of an experienced injector in your area.
Restylane for forehead crease
The risk of necrosis in this area is higher than other areas of the face. But just like all "off label" uses of injection products, the results and potential for side effects will depend on the skill of your practitioner.
We certainly respect the choices your physician is making in regard to injecting the forehead, but we believe Restylane is a good option for your problem and an option that we have used in many cases like yours. Good luck.
Juvederm or Restylane are often used to treat forehead wrinkles with Botox
Juvederm or Restylane are facial fillers which can often be used in conjunction with Botox to treat forehead wrinkles. Having said this, Botox for most people works great by itself; and is used for the horizontal forehead wrinkles, the vertical lines between the brows and the crows feet lines around the eyes.
However, sometimes, the vertical lines between the eyes are very deep and entrenched. That is when you know one of the facial fillers may be necessary. While complications can occur, I have treated hundreds of patients in this manner without even a hint of ulcerations.
Forehead, eyebrow shaping
You have a very good question and are correct about the 'off label' use of fillers in the forehead but it can be done safely.
The combination of the fillers and Botox can give a very long lasting and pleasing result.
With Warm Regards,
Trevor M Born MD
Your dermatologist is correct that there is a risk of ulceration or necrosis (death) of the skin surface. This can happen in this location if too much filler is used, or if too thick a filler is used. It is done without complication, but, this risk does exist in all cases.